Editorial introductions.

Editorial introductions.

Editorial introductions

Should Bone Metastases Causing Neuropathic Pain be Treated with Single-dose Radiotherapy?

Mwelecele Ntuli Malecela

Movie stars lead glamorous lives, attract enormous attention, and inspire popular lifestyle trends. Angelina Jolie, in particular, has been Hollywood’s highest paid actress in multiple years, cited as one of the world’s most beautiful women, married to perhaps the sexiest man alive, and empowered as a formidable marketing force. Her latest movie, Maleficent, generated total revenues greater than $700 million, an amount that could fund an entire medical center for more than a year. Her humanitarian efforts include being appointed Goodwill Ambassador for the United Nations High Commissioner for Refugees and channeling millions of dollars toward funding worthwhile charities. Many clinicians, scientists, and politicians might dream about having the influence of Angelina Jolie. On May 14, 2013, Angelina Jolie disclosed in an editorial titled ‘‘My Medical Choice’’ that she had tested positive for a breast cancer gene (BRCA1) and undergone prophylactic bilateral mastectomies with breast reconstruction. The immediate reaction led to widespread public attention including front-page stories in mainstream media and a doubling of subsequent referrals for BRCA1 genetic counseling at some hospitals. Her disclosure is also credited for helping shape the US Supreme Court deliberations on June 13, 2013, disallowing patents for isolated genes and potentially prohibitively expensive gene testing. In our opinion, no single study in medical decision science is likely to receive this amount of instant high-profile media attention. In the present issue of the journal, Seth Noar and colleagues provide a rigorous analysis tracking online search activity before and after the Angelina Jolie disclosure. The methods involved accessing the Google Trends database from January 1, 2010, to December 31, 2013, for daily searches related to breast cancer genetics and treatment queries (along with other relevant search terms). The findings indicated a large temporary surge in queries about genetics and treatment, a modest increase in queries about general information and risk assessment, and a rapid return to baseline after about 1 week. The implication is that Angelina Jolie spurred significant informationseeking about breast cancer genetic testing for a short time. The lack of sustained activity also underscores the fleeting nature of fame and public attention. Researchers in other fields might apply the same methods for informing their own studies of acute illnesses, chronic diseases, medical treatments, or unforeseen crises. The Google Trends database allows single or multiple combined word searches to organize each investigation toward relevant items. The resulting data are numerical, longitudinal, reproducible, accessible, immediate, and free. Another strength is the ability to stratify online trends by geographic region and thereby avoid selective reporting from a few outliers. A downside, however, is the need for statistical sophistication since the actual data are normalized as ‘‘relative search volume,’’ which hides the actual count of people involved (a restriction that protects the proprietary interests of Google Inc.). This type of research has been termed infodemiology and defined as the science examining the determinants and distribution of health information on the Internet. The general design involves monitoring Received 1 October 2014 from the Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (JB, DAR); Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada (JB, DAR); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (JB, DAR); Institute for Health Policy Management and Evaluation, Toronto, Ontario, Canada (DAR); Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (DAR); and Center for Leading Injury Prevention Practice Education & Research (DAR). Dr. Redelmeier is supported by the Canada Research Chair in Medical Decision Sciences. Revision accepted for publication 16 October 2014.

Academic cancer research in the UK is structured around key organizations. The National Cancer Research Institute (NCRI) is a ‘virtual institute’ that brings together government and charitable funders to set priorities and co-ordinate funding of cancer research. NCRI Clinical Studies Groups (CSGs), which provide the site-specific leadership to develop studies, will be adopted into the national portfolio of cancer studies as part of the National Institute for Health Research (NIHR) if the funding is available. The NIHR National Cancer Research Network leads the delivery of research through research networks throughout the UK. Related groups and initiatives facilitate or carry out specific tasks in research development, management and monitoring. Patients have input at all levels and their voice has, throughout the history of NCRI & NCRN, been considered critically important in developing research. The key principles from researchers and clinicians include working together with consumers as partners in the research effort, involving consumers in developing strategy as well as specific initiatives and studies, listening to the consumer voice on research needs and the experience of participating in research, and learning from experience to develop and increase the impact of the consumer role in cancer research. The NCRI Consumer Liaison Group brings together patient and caregiver members to support research development at all levels from the NCRI Board through CSGs to membership of individual Trial and Study Management groups. Impact has been captured in many narratives from researchers, clinicians and patients. Working together in a robust partnership is a particular strength of UK Cancer Research and forms the ideal platform to truly achieve research intended for patient betterment. This is recognized in the recent White Paper: ‘Equity and excellence: Liberating the NHS’. The organization's first decade of patient and public involvement is captured in the NCRI report: Patient, Carer & Public Involvement in Cancer Research. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr LB-73. doi:10.1158/1538-7445.AM2011-LB-73

Global Reluctance to Practice Evidence-based Medicine Continues in the Treatment of Uncomplicated Painful Bone Metastases Despite Level 1 Evidence and Practice Guidelines

David J. Tsoulis, MD, Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. Michael Cecchini, MD, Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. Yuliya Velykoredko, MD, Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. The authors declare no conflict of interest. Correspondence concerning this article should be addressed to Michael Cecchini, MD, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room M1-700, Toronto, ON M4N 3M5, Canada. E-mail: [email protected]

Farheen Mussani, BHSc, MD, Dermatology Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario. Jane Wu, BHSc, MD, Dermatology Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario. The authors declare no conflicts of interest. Correspondence concerning this article should be addressed to Farheen Mussani, BHSc, MD, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5. E-mail: [email protected]

he wider health impacts of the coronavirus disease 2019 (COVID-19) pandemic are of increasing concern, with an increase in rates of non-COVID-19 excess mortality observed. In England and the United States, the early pandemic was accompanied by a decline in patient visits to Emergency Departments (EDs), including those for cardiac diseases. 1, The decline may have been influenced by patient's reluctance to visit hospital due to the public health messages to protect National Health Service capacity, concerns about the risk of coronavirus infection, or difficulties in accessing medical care. The impact of delayed or nonpresentation to EDs with suspected cardiac disease on cardiac mortality is unknown. In this study, we used instrumental variable analysis to estimate the effects of reduced ED visits on cardiac mortality in England.

The Society of Biomolecular Imaging and Informatics First Annual Conference

Articles That May Change Your Practice: Right Patient, Right Crew, Right Destination

Specogna, AV; Patten, SB; Hill, MD; University of Calgary, Calgary, AB Background: Previous studies have examined predictors of treatment costs after Spontaneous Intracerebral Hemorrhage (ICH) in various countries and healthcare systems. Currently however, there is no clear understanding of which factors are associated with cost in any Canadian setting and thus no way of understanding how to plan ICH healthcare spending. Methods: We used a retrospective case series study design and adjusted linear regression to investigate if an association existed between the total cost of ICH hospital care in a Canadian health centre and age (years), gender (female vs. male), Charlson Comorbidity Index (0 vs. ≥1), in-hospital mortality (alive vs. dead), and having surgery (no vs. yes). Economic, treatment, and patient data were obtained from administrative sources. Total inflation-adjusted hospital cost per discharge was estimated in Canadian Dollars and log transformed for all analyses. Results: Analyses were performed using 987 consecutive ICH discharges from 1999 to 2008. The total cost of ICH hospital care was highly variable (mean cost per discharge=$25,613.96±$36,116.33; min $446.81 to max $326,275.10). Older age (β=–0.0057; 95% CI: –0.0103 to –0.0011) and death in hospital (β=–0.4859; 95% CI: –0.6357 to –0.3342) were significantly associated with lower total hospital cost per discharge. Whereas Charlson Comorbidity Index of ≥1 (β=0.6489; 95% CI: 0.5063 to 0.7916) and having surgery (β=1.3552; 95% CI: 1.1893 to 1.5210) were significantly associated with higher total hospital cost per discharge. Gender was not significantly associated with cost (β=0.0727; 95% CI: –0.0679 to 0.2134). Conclusions: To our knowledge this is the first study to examine predictors of ICH treatment costs in Canada. In a Canadian health centre, ICH treatment costs were significantly associated with patient age, level of comorbidity, in-hospital mortality, and surgical treatment. This study provides evidence that it may be reasonable to consider …

How Public Health Crises Expose Systemic, Day-to-Day Health Inequalities in Low- and-Middle Income Countries - An Example From East Africa

Recent studies suggest that circulating LDL (low-density lipoproteins) play a central role in the pathogenesis of atherosclerosis, and the oxidized form (ox-LDL) is highly atherogenic. Deposits of ox-LDL have been found in atherosclerotic plaques, and ox-LDL has been shown to promote monocyte recruitment, foam cell formation and the transition of quiescent and contractile vascular SMCs (smooth muscle cells) to the migratory and proliferative phenotype. SMC phenotype transition and hyperplasia are the pivotal events in the pathogenesis of atherosclerosis. To comprehend the complex molecular mechanisms involved in ox-LDL-mediated SMC phenotype transition, we have compared the differential gene expression profiles of cultured quiescent human coronary artery SMCs with cells induced with ox-LDL for 3 and 21 h using Affymetrix HG-133UA cDNA microarray chips. Assignment of the regulated genes into functional groups indicated that several genes involved in metabolism, membrane transport, cell–cell interactions, signal transduction, transcription, translation, cell migration, proliferation and apoptosis were differentially expressed. Our data suggests that the interaction of ox-LDL with its cognate receptors on SMCs modulates the induction of several growth factors and cytokines, which activate a variety of intracellular signalling mechanisms (including PI3K, MAPK, Jak/STAT, sphingosine, Rho kinase pathways) that contribute to SMC transition from the quiescent and contractile phenotype to the proliferative and migratory phenotype. Our study has also identified several genes (including CDC27, cyclin A1, cyclin G2, glypican 1, MINOR, p15 and apolipoprotein) not previously implicated in ox-LDL-induced SMC phenotype transition and substantially extends the list of potential candidate genes involved in atherogenesis.